Alfonso Rosales | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: Improving and maintaining clinical skills of frontline health workers over time is critical for strengthening health systems and providing adequate care to mothers, newborns, and children—supervision is widely recognized as key to improving health worker performance. Nonetheless, evidence on suitable supervision models for this level of care is scarce.

Methods: This research study describes and assesses a supervision model for illiterate community health workers (CHWs). Fifteen CHWs were trained and studied to assess correct use of health record forms; identification and classification of disease; treatment of sick children; referral to health facilities; and use and storage of tools and medical supplies. CHWs were visited weekly by a field supervisor for three months and then monthly for 10 months. Information was prospectively collected by individual observation and use of check-lists.

Results: 87% of CHWs were accredited as competent to deliver Integrated Community Case Management plus essential newborn care services. Other results included 95% of registration forms completed, only 7% discrepancy between classification of illness and drug administration, and all drugs accounted for with complete stocks. The overall referral initiation rate to primary health care unit found was 73%, with a 92% referral completion rate. A total of 2,552 children under age five were seen by CHWs, with a mean of 196 child visits per month.

Conclusion: Results showed CHWs to be effective in improving coverage of key MNCH practices, assessing mothers and children, and initiating treatment for malaria and diarrhea. Likewise, results suggest that a supervision process to monitor, improve and maintain clinical skill performance by CHWs within a community case management strategy is important. Supervision should be integral to health program design and implementation in order to obtain positive outcomes, especially within community-based approaches where treatment with drugs is included, and in fragile state contexts.